An Interpersonal Perspective on the Physiological Stress Response

Abstract

Abstract Stress management and related interventions are useful in the prevention and treatment of a variety of medical conditions, including coronary heart disease (CHD). These interventions improve emotional adjustment and reduce physiological stress responses that otherwise contribute to the underlying pathophysiology of the disease process. However, most of these interventions are based on a largely intrapersonal view of the psychophysiology of stress, with an emphasis on dampening physiological stress responses directly through relaxation, meditation or biofeedback approaches, or cognitive-behavioral approaches that alter stress-engendering cognitive processes (e.g., appraisals, cognitive distortions, rumination, worry). The present chapter presents an interpersonal view of stress and its impact on the development and course of CHD and discusses its implications for adjunctive interventions with this population. Based in the interpersonal tradition in clinical and personality psychology, this model identifies the two basic social motives of connection with others and status relative to others as key influences on physiological stress responses. The related dimensions of the interpersonal circumplex—affiliation and control—and other concepts in the interpersonal perspective provide an organizing framework for psychosocial risk and protective factors for CHD, as well as the psychophysiological mechanisms linking them with the disease process. Therapeutic implications of the affiliation dimension for stress management and related interventions include reduction of expression of and exposure to hostility, as well as increased expression of and exposure to warmth. For the control dimension, cultivation of autonomy as an alternative to both effortful expression of control or dominance and excessive deference or submissiveness is a potentially valuable focus for intervention. In pursuing these goals, several current psychological therapies can be incorporated into an interpersonally enhanced approach to stress management.